Factors that Influence Emergency Department Visits for Asthma

BACKGROUND: Asthma can usually be controlled through allergen avoidance and/or appropriate medication. An emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management. Emergency department treatment results in significant health care expenditures and reflects a compromised quality of life.OBJECTIVES: To identify risk factors associated with an emergency department visit for asthma.METHODS: This case-control study compared 299 people (76% of 390 cases contacted) who attended one of two emergency departments in Alberta in 1992 and 1993 for an acute exacerbation of asthma (cases) with 212 unmatched community controls with asthma who were located by random digit dialing. Cases and controls were asked to complete a mailed questionnaire to obtain data regarding severity, visits to doctors and emergency departments, medication use, allergies and other triggers, and smoking history. Data analysis included bivariate analysis of risk factors and multivariate model development using logistic regression.RESULTS: The response rate was similar between cases and controls. Cases were younger than controls (odds ratio [OR] 2.16, 95% CI 1.34 to 3.48) and more often reported their asthma to be severe (OR 4.25, 95% CI 2.24 to 8.06), and had experienced nocturnal symptoms (stratified OR range 1.36 to 6.82). Cases used more health care services in the previous year, had been admitted to hospital at some time for asthma (OR 1.62, 95% CI 1.10 to 2.38) and used more medication than controls.CONCLUSIONS: Physicians and other health care workers should be sensitive to the risk factors and target interventions to high risk individuals.

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Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis

Journal of Wrist Surgery ◽

10.1055/s-0041-1731821 ◽

2021 ◽

Author(s):

Thomas E. Moran ◽

Sheriff D. Akinleye ◽

Alex J. Demers ◽

Grace L. Forster ◽

Brent R. DeGeorge

Keyword(s):

Risk Factors ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Hospital Readmissions ◽

Emergency Department Visits ◽

Prescribing Patterns ◽

Care Utilization ◽

Proximal Row Carpectomy ◽

Opioid Prescribing

Abstract Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.

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Comparative Safety and Health Care Expenditures Among Patients With Chronic Myeloid Leukemia Initiating First-Line Imatinib, Dasatinib, or Nilotinib

JCO Oncology Practice ◽

10.1200/jop.19.00301 ◽

2020 ◽

Vol 16 (5) ◽

pp. e443-e455 ◽

Cited By ~ 6

Author(s):

Ashley L. Cole ◽

William A. Wood ◽

Benyam Muluneh ◽

Jennifer L. Lund ◽

Jennifer Elston Lafata ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Overall Survival ◽

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Health Care Expenditures ◽

Emergency Department Visits ◽

First Line ◽

Safety And Health ◽

Comparative Safety

PURPOSE: Tyrosine kinase inhibitors (TKIs) have dramatically improved survival for patients with chronic myeloid leukemia (CML). No overall survival differences were observed between patients initiating first- and second-generation TKIs in trials; however, real-world safety and cost outcomes are unclear. We evaluated comparative safety and health care expenditures between first-line imatinib, dasatinib, and nilotinib among patients with CML. PATIENTS AND METHODS: Eligible patients had one or more fills for imatinib, dasatinib, or nilotinib in the MarketScan Commercial and Medicare Supplemental databases between January 1, 2011, and December 31, 2016 (earliest fill is the index date), 6 months pre-index continuous enrollment, CML diagnosis, and no TKI use in the pre-index period. Hospitalizations or emergency department visits (safety events) were compared across treatment groups using propensity-score-weighted 1-year relative risks (RRs) and subdistribution hazard ratios (HRs). Inflation-adjusted annual health care expenditures were compared using quantile regression. RESULTS: Eligible patients included 1,417 receiving imatinib, 1,067 receiving dasatinib, and 647 receiving nilotinib. The 1-year risk of safety events was high: imatinib, 37%; dasatinib, 44%; and nilotinib, 40%, with higher risks among patients receiving dasatinib (RR, 1.17; 95% CI, 1.06 to 1.30) and nilotinib (RR, 1.07; 95% CI, 0.93 to 1.23) compared with those receiving imatinib. Over a median of 1.7 years, the cumulative incidence of safety events was higher among patients receiving dasatinib (HR, 1.23; 95% CI, 1.10 to 1.38) and nilotinib (HR, 1.08; 95% CI, 0.95 to 1.24) than among those receiving imatinib. One-year health care expenditures were high (median, $125,987) and were significantly higher among patients initiating second-generation TKIs compared with those receiving imatinib (difference in medians: dasatinib v imatinib, $22,393; 95% CI, $17,068 to $27,718; nilotinib v imatinib, $19,463; 95% CI, $14,689 to $24,236). CONCLUSION: Patients receiving imatinib had the lowest risk of hospitalization or emergency department visits and 1-year health care expenditures. Given a lack of significant differences in overall survival, imatinib may represent the ideal first-line therapy for patients, on average.

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P076: Calcium, magnesium and phosphorus dosing: impacts and relevance in the emergency department

CJEM ◽

10.1017/cem.2017.278 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S104

Author(s):

A. Lapointe ◽

S. Berthelot ◽

F. Rousseau

Keyword(s):

Risk Factors ◽

Health Care ◽

Emergency Department ◽

Strong Predictor ◽

Serum Levels ◽

Critical Issue ◽

Bivariate Analysis ◽

Quebec City ◽

Explanatory Variables ◽

Logistic Regressions

Introduction: With rising health care costs impairing access to care, the judicious use of diagnostic tests has become a critical issue for most jurisdictions. Among tests regularly performed in the emergency department (ED), calcium (Ca), magnesium (Mg) and phosphorus (P) laboratory testing represents an annual expenditure of more than $4 million for the Québec health care system. We then sought to determine the best indications for ordering these serum levels by identifying patient risk factors predicting abnormal results. Methods: We are conducting a retrospective cohort study in two academic hospitals of Québec City, one providing acute general care and the other providing specialized care to oncologic and nephrologic patients. We included 1000 patients who had serum Ca and/or Mg and/or P levels prescribed by an emergency physician between January 1st 2016 and May 1st 2016. We are collecting demographic (e.g. age) and clinical (e.g. comorbidities) characteristics identified from literature review as potential explanatory variables of an abnormal serum level. Predictive models of a positive test result will be derived from logistic regressions. Results: We have evaluated 143 patients. ED prevalence rates of hypo- and hyper-calcemia (10.1% and 4,3%), hypo- and hyper-magnesemia (13.0% and 7,2%), hypo- and hyper-phosphatemia (9.5% and 13,9%) were similar to those reported in literature. Preliminary bivariate analysis (p<0.05) have shown that, for patients who had serum Ca/Mg/P levels prescribed, one in four complained of weakness, one in five complained of abdominal pain and one in five presented on physical examination an abnormal mental status. Acute and chronic renal failure appears to be a strong predictor of anomalies of any of those electrolytes. Neoplasia, metastasis, hallucinations, bone pain and confusion are more specifically associated with hypercalcemia. Use of corticosteroids is associated with hypocalcemia. Conclusion: Our bivariate analyses have identified potential risk factors of abnormal Ca/Mg/P results. Multivariate logistic regressions will be conducted on the complete planned cohort to further test these preliminary results.

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Risk factors of hospital admissions and recurrent emergency department visits among pediatric asthma patients

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1586725862 ◽

2020 ◽

pp. 1011-1015

Author(s):

Abdullah Aldamigh ◽

Afaf Alnefisah ◽

Abdulrahman Almutairi ◽

Fatima Alturki ◽

Suhailah Alhtlany ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admissions ◽

Pediatric Asthma ◽

Emergency Department Visits ◽

Asthma Patients

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Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.791 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S333-S334

Author(s):

So Lim Kim ◽

Angela Everett ◽

Susan J Rehm ◽

Steven Gordon ◽

Nabin Shrestha

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admission ◽

Vascular Access ◽

Antimicrobial Therapy ◽

Cleveland Clinic ◽

Emergency Department Visits ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Ed Visits ◽

Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost

Plastic Surgery ◽

10.1177/22925503211019627 ◽

2021 ◽

pp. 229255032110196

Author(s):

Martin P. Morris ◽

Adrienne N. Christopher ◽

Viren Patel ◽

Ginikanwa Onyekaba ◽

Robyn B. Broach ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Clinical Outcomes ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Body Contouring ◽

Emergency Department Visits ◽

Smoking History ◽

Care Utilization ◽

Wound Therapy

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort ( P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

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Transitions in “Privatized” Prison Health Systems: Emergency Department Visits and Hospitalizations Among Incarcerated People in Florida, 2011–2018

American Journal of Public Health ◽

10.2105/ajph.2020.305988 ◽

2021 ◽

pp. e1-e4

Author(s):

Jessica L. Adler ◽

Weiwei Chen ◽

Timothy F. Page

Keyword(s):

Public Health ◽

Health Care ◽

Emergency Department ◽

Hospital Discharge ◽

Emergency Department Visits ◽

Care Utilization ◽

Discharge Data ◽

Prison Health ◽

Discharge Rates ◽

Care Problems

Objectives. To examine rates of emergency department (ED) visits and hospitalizations among incarcerated people in Florida during a period when health care management in the state’s prisons underwent transitions. Methods. We used Florida ED visit and hospital discharge data (2011–2018) to depict the trend in ED visit and hospital discharge rates among incarcerated people. We proxied incarcerated people using individuals admitted from and discharged or transferred to a court or law enforcement agency. We fitted a regression with year indicators to examine the significance of yearly changes. Results. Among incarcerated people in Florida, ED visit rates quadrupled, and hospitalization rates doubled, between 2015 and 2018, a period when no similar trends were evident in the nonincarcerated population. Public Health Implications. Increasing the amount and flexibility of payments to contractors overseeing prison health services may foster higher rates of hospital utilization among incarcerated people and higher costs, without addressing major quality of care problems. Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e4. https://doi.org/10.2105/AJPH.2020.305988 )

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